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  • Microsuction Ear Wax Removal
  • Migraine
  • Private & Free NHS Hay Fever Treatment
  • Skin Care
  • Sexual Health
  • Seasonal Health
  • Smoking Cessation
  • Travel Health Clinic
  • Travel Vaccination Service
  • Vaccination Service
  • Weight Loss Treatments
  • Women's Health
  • Skin
  • Acne
  • Aesthetics Service
  • Common Ailment NHS Scheme
  • Skin Care
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  • Travel Vaccination Service
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Trade account opening form

Fill out the form below and we will contact you within 48 hours once your account has been set up.

By submitting this form, you agree to the processing and storage of your personal information as set out in our Trade Account Privacy Policy. * Mandatory field

Your Details

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Date of Birth*

Professional in Charge

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Business Details

Business Address & Contact Details

Prescriber Details

Are you a prescriber?*
Do you require a prescriber?*
Who would you like to approve your prescriptions?*

Medical Profession Details

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Delivery Address

The delivery address is the same as the main business address*

Company Personnel

Purchasing Contact Details

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Accounts Contact Details

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Credentials

Proof of ID

Copy of Indemnity Insurance

Please make sure that the expiry date of your insurance is visable on the documents that you upload

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  • Must meet at least 2 of the following conditions:
    • have a mix of upper and lower case characters
    • have at least one numeric character
    • have at least one ‘special’ character (such as space or punctuation)

Agreement

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By submitting this form, you agree to the processing and storage of your personal information as set out in our Trade Account Privacy Policy.

Seren Plus. MHRA site number: 40635. GPHC registration: 1092601.
Registered address: Churchgate house, Church road, Cardiff, CF14 2DX. Company House: 07767695. VAT: GB125263926.

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Registration Number: 10926012025 Health Plus Pharmacy. All rights reserved.